FORMING A CWMP

Who can form a CWMP? A person or entity may apply to the Commissioner of Health to have a workplace medical plan certified.

Statutory Requirements 85 O.S Provide quality medical services using approved medical treatment guidelines. Provide geographic convenience. Provide financial incentives to reduce service costs and utilization without sacrificing quality. Provides peer review, utilization review and dispute resolution. Provides aggressive case management and return to work programs Provides workplace health and safety consultative services Provides a timely and accurate reporting to the Commissioner Provide for necessary emergency medical treatment outside the plan Do not discriminate against or exclude any category of providers of medical, surgical, or hospital services and includes an adequate number of each category of providers Meets all other requirement of the Commissioner of Health

Health Department Requirements OK. Health Department Rules 310: Necessary medical and health services are provided as guaranteed in the Plan's contracts with insurers and insureds and in the provider directory. All providers practice under licensing, certification or credentialing requirements of applicable laws, rules and professional standards. Medical and health services are available within the Plan's service area, considering the geographic location of the Plan and its providers, hours of operation, and population density. The Plan appoints a qualified medical director. The Plan maintains quality assurance, peer review, utilization review, dispute resolution, case management, and workplace health and safety consulting services. The Plan demonstrates financial responsibility. The persons responsible for the Plan must have knowledge, skills and experience to operate the Plan.

Can CSO Form a CWMP? Probably CSO has statutory authority: Under 85 O.S. 134, the President has full power and authority to contract with physicians, surgeons and hospitals for medical and surgical treatment and the care and nursing of injured persons entitled to benefits from said fund. But, the Commissioner may refuse: The Commissioner may not consider section 134 specific enough to allow CSO to form a CWMP. The Health Department can refuse an application for a CWMP with insurers who have an interest in the Plan if the Plan does not safeguard the fairness and equity of medical and health service delivery.

Can CSO help form a CWMP? Maybe It will be easier for CSO to rely upon our authority to contract with a CWMP. But, The Health Department requirement to safeguard fairness and equity still apply where we: 1.occupy a position as the Plan's director, governing member, officer, agent, or employee; 2.have any ownership, financial or investment interest in the Plan; 3.have any contract with the Plan that limits the Plan's ability to accept business from any other source; or 4.Have any relationship with a Plan, other than a contract for provision of medical and health services under the Act. Any agreement will also require review of the relationship in light of our statutes, Title 36, and the State Ethics rules.